Several years ago, an anesthesiologist in California watched pilots training on flight simulators. He noticed that both pilots and medical teams have to be able to work under a variety of conditions, including high amounts of stress. If pilots could train in an environment that simulated weather emergencies and gave them guidance on how to deal with them, he thought, surely physicians, nurses and other medical professionals could also practice working under emergency conditions in a simulated environment.
Thus, the idea for the Center for Medical Simulation (CMS) was born. A joint venture between the Anesthesia departments of Harvard Medical School’s teaching hospitals, the Center offers medical professionals the chance to simulate a medical emergency in a realistic environment. Although anesthesiologists were the first groups to be trained at the center, various medical staff members—including residents and faculty in radiology, emergency medical teams, intensive care workers, MedFlight staff and first-third year medical students—now regularly schedule training programs there.
One team at BWH that benefits from this center is the “Code Blue” team. The team is training to be an on-call emergency team that will respond to “Code Blue”s or cardiopulmonary emergencies. The designated team of physicians, nurses, respiratory therapists and other medical staff are trained specifically to handle these emergencies. By training through a simulation together as a team, rather than separately and grouped by profession, the levels of communication and collaboration are increasing immensely with every session.
In their simulation, the Code Blue team works to resuscitate a computerized patient mannequin whose vital signs are rapidly failing. As the patient’s blood pressure drops and various unforeseen difficulties occur, the team members get a lifelike lesson in communicating and practicing their skills while under extreme pressure. When the staff members do something to the patient—such as give an injection, make an incision or diagnose a condition—the simulation staff members in the control room use a computer system to make the patient and the patient’s vital signs react as a human being would. The extremely lifelike “dummy” that has a pulse, can blink and even can speak
completes the realistic atmosphere of the scenario.
After the simulation, the team watches a video of their work, complete with the patient’s vital signs superimposed on the screen. Along with Erin Graydon-Baker, MS, RRT, education director and Dan Raemer, PhD, program director, the team members discuss mistakes, teamwork concepts and ways to improve. They also note methods that were successful and ways in which communication helped a problem. The team then practices their skills in a second simulated emergency. A review of the emergency equipment, the importance of arrest documentation and updates in medical therapies are included in the training.
“Collaboration between medical teams is always important, but it’s especially critical during an emergency event,” said Graydon-Baker. “When you’re under a high amount of stress, making decisions and consulting with your co-workers becomes more and more difficult. These simulations are a great way for the team members to really gauge how well they are working with their peers, and how they can improve in the future.”
Members of the Code Blue team who have been to CMS agree that they learn skills and behaviors that they can apply to a real code. “I really enjoyed the session. Being involved in several codes in the past, I had much to learn. The taping was very helpful,” says one of the senior medical residents on the team.